診療看護師が職務上経験する倫理的問題

Ethical problems experienced by Japanese Nurse Practitioner in their work

　本研究の目的は、特定行為を含む診療に関わる診療看護師が、職務上経験した倫理的問題を把握することである。日本NP教育大学院協議会が資格認定した診療看護師249名を対象とし、無記名自記式質問紙調査を行い54件の回答を得た。その結果、「患者の身体拘束・鎮静をすること、しないこと」看護の倫理原則である「患者の権利擁護」や「十分なケアを提供できない人員配置」の問題を高い頻度で経験していた。さらに、医師との信頼関係の構築や、看護師の上司や同僚との対人関係の問題に悩んでいた。

　診療看護師が抱える倫理的問題は、臨床看護師と同様の結果であり、看護師として倫理的感性が結果に反映されていると考えられる。加えて鎮静に関しては、診療看護師の経験として重要な問題となる。診療看護師は、医師や看護師との関係性に問題を抱え、教育の課程領域による問題の違いも示唆された。大学院修士課程での看護倫理教育をさらに発展させる必要がある。

　The purpose of this study is to understand the ethical issues experienced by nurse practitioners who provide medical care, such as “tokutei koui” (designated duties). The nurse practitioners in this study were designated as shinryo-kangoshi in Japan. A questionnaire survey was conducted on 249 nurse practitioners certified by the Japan NP Graduate School of Education Council, and 54 responses were analyzed. As a result, the nurse practitioner experienced many ethical issues such as “physical restraint: sedation or not,” “advocacy of patient rights,” and “staffing that could not provide adequate care.” And they were suffering from the ethical issue of “relationships with doctors and nurses.”

　The ethical issues experienced by nurse practitioners are similar to those of clinical nurses, and their ethical sensibility as nurses might be reflected in the results. In addition, sedation is the important issue of participants' experiences as nurse practitioners. Nurse practitioners have ethical problems with their relationships with doctors and nurses, suggesting differences in issues across the field of education. There is a need for further development of ethics education in the master's program at the graduate school.